吕怡 刘培 蒋鹏飞 彭俊 彭清华

〔摘要〕 古今医家对干眼病机已有诸多论述，但干眼所致疼痛病機却较少被人关注。临床上有部分干眼患者的疼痛症状强于眼部干涩症状，痛苦显著，极大影响患者生活质量。通过中医学理论与现代医学相结合的方式，从经络不荣与不通和脏腑失和这两个方面阐释干眼所致疼痛的中医病机。提出肺肾阴液亏虚、脾肾阳虚寒凝、心肝气郁血阻导致干眼疼痛，以期为临床治疗提供更多的思路。

〔关键词〕 干眼;疼痛;中医;病机;脏腑失和

〔中图分类号〕R276.7       〔文献标志码〕A       〔文章编号〕doi：10.3969/j.issn.1674-070X.2021.10.014

Traditional Chinese Medicine Pathogenesis Analysis of Pain in Dry Eye Disease

LV Yi1，2， LIU Pei1，2， JIANG Pengfei1，2， PENG Jun2，3， PENG Qinghua1，2*

（1. Hunan University of Chinese Medicine， Changsha， Hunan 410208， China; 2. Hunan Engineering Technology

Research Center for the Prevention and Treatment of Otorhinolaryngologic Diseases and Protection of Visual

Function with Chinese Medicine， Changsha， Hunan 410208， China; 3. The Affiliated Hospital of Hunan

University of Chinese Medicine， Changsha， Hunan 410007， China）

〔Abstract〕 There have been many discussions about the pathogenesis of dry eye disease from ancient times to the present， but the pathogenesis of dry eye pain has been less concerned. Clinically， some patients with dry eye have obvious eye pain symptoms， even more serious than the dry symptoms， which will bring more pain to patients and significantly influence the quality of life among patients. In this study， we will shed light on the traditional Chinese medicine （TCM） mechanism of dry eye pain from meridians of no nourishing and obstruction and Zang-Fu dysregulation by integrating TCM theory with modern medicine. In addition， this article innovatively proposes the discussion of dry eye pain caused by lung-kidney Yin liquid deficiency， spleen-kidney Yang deficiency cold coagulation， and heart-liver Qi depression blood stasis in the hope of providing more ideas for clinical treatment.

〔Keywords〕 dry eye disease; pain; traditional Chinese medicine; pathogenesis; visceral disharmony

干眼致病因素较多，发病机制也较为繁杂，成为国内外眼科研究的热点。干眼病至后期，眼部疼痛症状明显，甚至疼痛症状强于干涩症状;亦有部分患者甚至疾病初起就存在症状与体征分离的现象，即干眼症状典型（如干涩疼痛感明显）而相关体征均正常，刘祖国教授将这种情况称为功能性干眼[1]。这种疼痛往往难以缓解，给患者带来极大的痛苦，影响患者生活质量。中医学对疼痛的病因病机有独特的认识，本文运用中医学与现代医学理论阐释干眼所致疼痛的中医病机，以期为临床治疗提供更多的思路。

干眼所致疼痛属于慢性疼痛，中医学将疼痛分为气痛和形痛，气伤致痛是指无形邪气与七情内伤结合作用于人体，使气机受损而发为疼痛[2]。而干眼所致疼痛并非有形之邪直接损伤，属于气痛一类。经络气血、脏腑虚实、情志内伤基本构成了气痛的病机，以下将结合中西医理论从这些方面阐释干眼所致疼痛的中医病机。……